Study of post-operative pulmonary complications in patients of emergency abdominal surgeries

Verma, Siddhartha; Bhardwaj, Ankur; Patil, Sagar Manohar

doi:10.18203/2349-2902.isj20183723

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…Kumar et al studied one hundred and fifty patients who underwent abdominal surgery, and of these, 16% developed PPCs and the highest incidence occurred in the emergency surgery group too [25]. Verma et al conducted a study of PPCs in patients of emergency abdominal surgeries and found that pre-operative abnormal chest X-ray changes were 3 times more common in the PPCs group as compared to the control group without PPCs [26]. In our study, no significant association was observed between this variable and the occurrence of PPCs.…”

Section: Discussionmentioning

confidence: 99%

Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study

et al. 2019

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BackgroundPostoperative pulmonary complications (PPCs) contribute significantly to overall postoperative morbidity and mortality. In abdominal surgery, PPCs remain frequent. The study aimed to analyze the profile and outcomes of PPCs in patients submitted to abdominal surgery and admitted in a Portuguese polyvalent intensive care unit.MethodsFrom January to December 2017 in the polyvalent intensive care unit of Hospital Garcia de Orta, Almada, Portugal, we conducted a retrospective, observational study of inpatients submitted to urgent or elective abdominal surgery who had severe PPCs. We evaluated the perioperative risk factors and associated mortality. Logistic regression was performed to find which perioperative risk factors were most important in the occurrence of PPCs.ResultsSixty patients (75% male) with a median age of 64.5 [47–81] years who were submitted to urgent or elective abdominal surgery were included in the analysis. Thirty-six patients (60%) developed PPCs within 48 h and twenty-four developed PPCs after 48 h. Pneumonia was the most frequent PPC in this sample. In this cohort, 48 patients developed acute respiratory failure and needed mechanical ventilation. In the emergency setting, peritonitis had the highest rate of PPCs. Electively operated patients who developed PPCs were mostly carriers of digestive malignancies. Thirty-day mortality was 21.7%. The risk of PPCs development in the first 48 h was related to the need for neuromuscular blocking drugs several times during surgery and preoperative abnormal arterial blood gases. Median abdominal surgical incision, long surgery duration, and high body mass index were associated with PPCs that occurred more than 48 h after surgery. The American Society of Anesthesiologists physical status score 4 and COPD/Asthma determined less mechanical ventilation needs since they were preoperatively optimized. Malnutrition (low albumin) before surgery was associated with 30-day mortality.ConclusionPPCs after abdominal surgery are still a major problem since they have profound effects on outcomes. Our results suggest that programs before surgery, involve preoperative lifestyle changes, such as nutritional supplementation, exercise, stress reduction, and smoking cessation, were an effective strategy in mitigating postoperative complications by decreasing mortality.

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Section: Discussionmentioning

confidence: 99%

Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study

et al. 2019

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Postoperative pulmonary complications in patients undergoing upper abdominal surgery: risk factors and predictive models

Garg,

Govindaraj,

Dwivedi

et al. 2024

Monaldi Arch Chest Dis

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Postoperative pulmonary complications (PPCs) are unexpected disorders that occur up to 30 days after surgery, affecting the patient’s clinical status and requiring therapeutic intervention. Therefore, it becomes important to assess the patient preoperatively, as many of these complications can be minimized with proper perioperative strategies following a thorough preoperative checkup. Herein, we describe the PPCs and risk factors associated with developing PPCs in patients undergoing upper abdominal surgery. Additionally, we compared the accuracy of the American Society of Anaesthesiologists (ASA) score, the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score, the 6-Minute Walk Test (6MWT), and spirometry in predicting PPCs. Consenting patients (>18 years) undergoing elective upper abdominal surgery were recruited from November 2021 to April 2023. Clinical history was noted. Spirometry and 6MWT were both performed. Pre-operative ASA and ARISCAT scores were recorded. Postoperative follow-up was conducted to assess respiratory symptoms and the occurrence of PPC. PPC was defined as per EPCO guidelines. A total of 133 patients were recruited, predominantly male. A total of 27 (20.3%) patients developed PPCs. A total of 14 (10.5%) patients had more than one PPC. The most common PPCs developed were pleural effusion (11.3%), respiratory failure (7.5%), and pneumonia (4.5%). We obtained ten statistically significant associated variables on univariable analysis, viz obstructive airway disease (p=0.002), airflow limitation (p=0.043), chest radiography (p<0.001), albumin (p=0.30), blood urea nitrogen (BUN) (p=0.029), aspartate aminotransferase (p=0.019), alanine aminotransferase (p=0.009), forced expiratory volume in one second/forced vital capacity ratio (p=0.006), duration of surgery (p<0.001), and ASA score (p=0.012). On multivariable regression analysis, abnormal chest radiograph [odds ratio: 8.26; (95% confidence interval: 2.58-25.43), p<0.001], BUN [1.05; (1.00-1.09), p=0.033], and duration of surgery [1.44; (1.18-1.76), p<0.001] were found to be independently associated with PPC. The ASA score was found to have better predictive power for the development of PPCs compared to the ARISCAT score but is of poor clinical significance. Additionally, 6MWD and spirometry results were found to lack any meaningful predictive power for PPC. To conclude, preoperative evaluation of the chest radiograph, BUN, and duration of surgery are independently associated with developing PPCs. The ASA score performs better than the ARISCAT score in identifying patients at a higher risk of developing PPCs and implementing preventive measures.

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Perioperative risk factors for pulmonary complications after non-cardiac surgery

Gupta

Fernandes

Rao

et al. 2020

J Anaesthesiol Clin Pharmacol

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Study of post-operative pulmonary complications in patients of emergency abdominal surgeries

Cited by 3 publications

References 9 publications

Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study

Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study

Postoperative pulmonary complications in patients undergoing upper abdominal surgery: risk factors and predictive models

Perioperative risk factors for pulmonary complications after non-cardiac surgery

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